Treatment for generalized myasthenia gravis (MG) in the United States remains heavily dependent on steroids, with frequent treatment interruptions and limited use of newer targeted therapies, according to a large real-world analysis recently presented at the 2026 American Academy of Neurology annual meeting in Chicago, Illinois.
These findings suggest that many patients continue to face inconsistent disease control and barriers to more advanced care options.
Researchers examined how patients are actually treated in routine practice to better understand whether current approaches are meeting patient needs. The study included 44,525 adults with generalized MG identified through insurance claims from 2018 to 2024.
Nearly half of patients (48%) were treated with oral corticosteroids, making them the most commonly used therapy. Nonsteroidal immunosuppressive therapies were used in 25% of patients, while biologic treatments were used in only 6%. Among biologics, rituximab, eculizumab and efgartigimod were the most frequently prescribed.
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“High reliance on corticosteroid monotherapy and repeated cycling highlight persistent unmet need in managing [generalized] MG, underscoring the importance of expanding access to effective targeted therapies,” the study’s authors said.
Most patients (57%) received just one treatment at a time, while 16% used combination therapy. Steroid exposure was substantial. About 22% of patients received doses of at least 20 mg per day, while 17% received between 10 and less than 20 mg per day. Smaller proportions received lower doses. The average length of time patients stayed on their first treatment was 292 days.
Treatment changes were common. When a treatment regimen ended, it was most often due to stopping therapy altogether (61%), followed by adding another treatment (15%) or switching to a different one (9%). Notably, 35% of patients cycled on and off steroids, with gaps of at least 60 days between courses. This pattern suggests that many patients are not moving steadily to more effective long-term therapies but instead returning to steroids repeatedly.
For patients, these findings may help explain why symptoms can remain unpredictable or why side effects from steroids persist over time. Repeated steroid use can carry risks, especially at higher doses, and limited access to newer therapies may delay better disease control. The results point to a need for more consistent treatment strategies and improved access to targeted therapies that could reduce reliance on steroids and improve quality of life.
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